Anesthesia and Surgical Complications Flashcards

1
Q

If we can’t intubate and can’t ventilate what do you NOT do?

A

do not give paralytic until you can verify ability to ventilate

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2
Q

If you cannot ventilate the patient,

A

insert LMA

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3
Q

Conditions necessitating continued intubation:

  • E
  • E
  • R
  • H
  • B
  • O
A
  • epiglottitis
  • localized edema
  • recurrent laryngeal nerve damage
  • hemodynamic instability
  • bleeding
  • prolonged obtundation (anesthetics, metabolic abnormalities, neuro injury)
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4
Q

respiratory problems occur in________

airway obstruction
hypoventilation
hypoxemia

A

PACU:

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5
Q

Airway obstruction causes (7)

  • P
  • S
  • L
  • G
  • V
  • B
  • P
A
  • posterior displacement of tongue
  • secretions
  • laryngospasm
  • glottic edema
  • vomitus
  • blood in airway
  • external pressure on trachea
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6
Q

Corrective measures for air obstructions:

A

oxygen supplementation

jaw thrust, head tilt

NAW preferred, OAW

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7
Q

If obstruction still exists consider what is happening?

A

laryngospasm

PPV and jaw thrust

0.1 mg/kg or 10-20 mg of Succx

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8
Q

If PaCO2 > 45mmHg consider what is happening?

A

hypoventilation

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9
Q

A significant value for PaCO2 >____ mmHg or pH is < ______.

Primary cause for hypoventilation is:

A

60 mmHg

7.25

too many narcotics, patients don’t want to breath

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10
Q

Signs of hypoventilation:

  • S
  • A
  • R
  • T
  • L
A
  • somnolence
  • airway obstruction
  • slow RR
  • tachypnea with shallow breathing
  • labored breathing
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11
Q

Respiratory acidosis = (2)

Cardiac irritability = (1)

A

HTN, tachypnea

cardiac depression

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12
Q

Hypoventilatin is most common respiratory problem in PACU. true or false.

A

true

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13
Q

Signs of residual paralysis:

A

discoordinated movements

shallow TV

tachypnea

head lift < 5 secs

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14
Q

Hypoventilation due to splinting due to pain may be caused from:

A

from upper/lower GI Sx

abdominal distension

tight dressings

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15
Q

Cons of opioid antagonists to treat hypoventilation:

A
  • pain
  • HTN crisis
  • pulmonary edema
  • myocardial infarction/ischemia
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16
Q
  • restlessness
  • tachycardia

cardiac irritability early signs

A

Signs of hypoxia, PaO2 < 60 mmHg

17
Q

Signs of hypoxia: late signs:

A

obtunded (comatose)

bradycardia

hypotension

cardiac arrest

18
Q

Hypoxia due to:

A
  • hypoventilation
  • R-L shunting (blood going from r–>l of heart without being oxygenated)
  • intrapulmonary shunting from decreased FRC due to GA
19
Q

Intrapulmonary shunting can occur (3)

A
  • pulmonary atelectasis caused by insufficient TV delivery
  • parenchymal infiltrates aka pulmonary edema
  • pneumothorax aka lung collapse
20
Q

Cause of intrapulmonary shunting:

A
  • prolonged hypoventilation
  • endobronchial intubation (tube in too deep)
  • pulmonary aspiration
  • pulmonary edema
21
Q

If x-ray is white, means lung is ________.

A

unventilated

More than likelly fluid is built up in the lung cavity.

22
Q

The carina is normally at the T_-T__ level.

23
Q

Hypoxia treatment involves:

A
  • 100% O2 nonrebreathing mask or ETT
  • diuretics for fluid overlad
  • brochodilators for bronchospasms
  • PEEP/CPAP for atelectasis
24
Q

Most GI complications involve:

A
  • autonomic afferents from GI mediastinum
  • vestibular CN 8
  • visual//cortical stimuli
  • chemoreceptor trigger zone
25
Most common circulatory complications in PACU:
* hypotension * hypertension * arrhythmias
26
Always consider possibility of circulatory abnormalities from respiratory disturbances. True or false?
true
27
Concerned with BP \>= ___ baseline reduction
30%
28
What are causes of hypotension?
decreased venous return--hypothermic venoconstriction, hypovolemia, third spacing, post op blood loss LV dysfunction--pneumothorax, cardiac tamponade, fluid overload, CAD, valvular disease Excessive arterial vasodilatation--neuraxial procedures, adrenergic blockade venodilators, sepsis, allergic reaction
29
Hypertension primary causes: (3)
* noxious stimuli * endotracheal intubation * bladder distension
30
hypoxemia hypercapnea metabolic acidosis elevated CVP vascular volume overload
* Secondary causes of hypertension: (5)
31
* look at ST indicates ischemia * respiratory disturbances, hypoxemia, hypercarbia, and acidosis * residual effects of anesthetics
Arrhythmias
32
Abnormal EKG requiring treatment:
* ventricular tachycardia * vent fib * Sinus brady/asystole * ST with hemodynamic instability